A Systematic Review Of Integrated Traditional Chinese Medicine With Western Mdedicine For Psoriasis Vulgaris

Background:Psoriasis was a common chronic inflammatory skin disease and was easy to recur,which was divided into four clinical types:psoriasis vulgaris,pustular psoriasis,psoriatic arthritis and erythrodermic psoriasis.Psoriasis vulgaris was the most common clinical type.The main clinical manifestations was covering general squamous erythemathe and characteristic punctate hemorrhage.The pathological feature included epidermal keratinocytes(KCs) excessive proliferation and abnormal differentiation,lymphocytes(mostly T cells) infiltration,dermal vascular changes,such as angiogenesis,expansion,transfer music, high endothelial angiogenesis.According to 1984 National Psoriasis collaborative research group's findings showed that the prevalence rate was about 0.123%,the incidence rate was about 0.12%, male sex was higher than female sex,urban was higher than countryside,north was higher than south.Abroad,prevalence rate of psoriasis prevalence was 1%to 3%,the white of Europe and North America were most common,African-American rare,the Indians hardly incidence.There were no satisfactory treatments for it,the majority could only achieve short-term effect,but could not stop recurrence.In recent years,with the continuous development of science and biology,the pathogenesis of psoriasis had a better understanding and thereby facilitate the treatment of this disease hda a new research developments such as immunotherapy,photodynamic therapy,anti-angiogenesis drugs.Western Ways,however it had a lot of the adverse reactions,such as frequent long-term PUVA treatment,may lead to skin cancer;application cortical steroid, vitamin D and cytotoxic drugs of conventional therapy,there were also many side effects.Chinese medicine treatment of psoriasis in China had thousands of years,Chinese medicine in the treatment of psoriasis on showed certain advantages.In recent years,a lot of clinical trials had combined Chinese and Western treatment of psoriasis vulgaris were studied the efficacy,but these tests the quality and efficacy has not been systematically evaluated.Objective:To systematically evaluate the clinical efficacy and safety of integrated traditional Chinese medicine with western medicine(ICWM) in the treatment of vulgaris psoriasis,expecting to provid the true and reliable foundation for clinical rational drug use,to help us to better guide clinical medication.Methods:search strategy:electronic retrieval china journal full-text database(1998-2009.3),chinese sci-tech periodical full-text database(1998-2009.3),wang fang figure full-text database(1996-2009.3);hand retrieval the Intemet performed handsearching in Chinese journals and reference lists.Data collection and analysis:2 reviewers independently evaluated and extracted data,according to pre-formulate the data tables to extract data,methodological quality using Jadad score and allocation concealment classification evaluation of the program, application software with RevMan 5.0.18 homogeneity Meta-data analysis,eligible studies:We included randomised controlled trials and prospective controlled studies of integrated Chinese medicine with western medicine versus western medicine alone or integrated Chinese medicine alone in people with vulgaris psoriasis.Observation of object:According to the "Clinical Dermatology" diagnostic criteria for diagnosis of vulgaris psoriasis.Interventions:the treatment group using TCM-WM treatment,the control group alone therapy or traditional Chinese medicine and Western Medicine.Main outcome measures:â‘ The clinical efficacy;â‘¡security;â‘¢relapse rate.Secondary outcome measures:â‘ the quality of life of patients Changed;â‘¡The follow-up and Lost.Results:Ultimately 11 literatures were identified,in which there were 11 randomized controlled trials(RCTs).The patient numbers was 1901.ThePublished periods of the trials were from 1998 to 2008.All literatures were published in chinese.All 11 literatures probability existed selective bias,sexual bias,detection bias.The following ICWM and WM treatment of difference has statistical significance,and better than WM:The clinical efficacy [OR 2.85,95%CI(2.12,3.83)],the relapse rate[OR 0.27,95%CI (0.10,0.73)];the following ICWM and ICM of simple differences have statistical significance,and is superior to pure ICM:The clinical efficacy[OR 3.05,95%CI(2.09,4.45)],the relapse rate[OR 0.22,95%CI(0.08,0.60)]Quality of life:before and after treatment in patients with four areas to improve the quality of life, sickness Dimension[WMD 0.61,95%CI(0.32,0.90)],the biological dimension of[WMD -0.16,95%CI(-0.44,0.12)],psychological dimension[WMD 0.33,95%CI(0.05,0.62)]and social dimensions[WMD 0.22,95%CI(-0.07,0.50)],prompted the clinical efficacy and improved quality of life was positively correlated.Conclusions:Chinese and Western combined treatment of psoriasis vulgaris better than a simple Western medicine or simple chinese on clinical efficacy,low recurrence rate,and Western medicine can significantly reduce adverse reactions and improve the patients quality of life.However,Chinese and Western therapy randomized controlled clinical study report of the quality of literature were not high enough,future research should pay attention to sample size estimation,randomization method,blind applications and standardize the description of baseline comparability,as well as cases of lost records and analysis.